Dialysis Event Reporting and Prevention Efforts in Tennessee

BACKGROUND:   The Tennessee Department of Health (TDH) made dialysis events (DE) reportable to the National Healthcare Safety Network (NHSN) in 2012.  This required all outpatient hemodialysis (OHD) facilities to report at least 3 consecutive months of data according to the NHSN protocol; from 2013 onward, facilities are required to report 12 months of data, a mandate which aligns with Centers for Medicaid and Medicare Services requirements.  TDH actively partnered with End Stage Renal Disease (ESRD) Network 8 to engage OHD facilities in prevention and mandated reporting.

METHODS:   Initial NHSN enrollment and training efforts in early 2012 mirrored prior successful activities including direct outreach and the use of instructional webinars. We partnered with ESRD Network 8 staff to take advantage of their existing relationships with OHD facilities and large dialysis organizations (LDOs) and their knowledge of CMS initiatives. TDH staff provided written guidance on NHSN enrollment and conferring rights, which was distributed by Network 8 to OHD administrators and LDO leadership.  TDH staff also provided one-on-one assistance to facilities needing extra support. Following enrollment, TDH began monitoring data periodically for indications of possible infection control problems at individual facilities. Facilities are jointly contacted by TDH and Network staff, and offered infection prevention guidance and resources.  Data quality monitoring, which will include monthly reports to facility administrators, will begin in early 2014.

RESULTS: Among Tennessee’s 154 OHD facilities, 134 (87%) are distributed among 3 LDOs, and 20 (13%) are independently operated. There are 34 unique facility administrators, with one user designated as administrator for 53 facilities. After the first TDH training webinar, in September 2012, 18 (12%) of facilities had enrolled, and 6 (4%) had conferred rights to TDH. Within one month after the Network distributed simplified written guidance, the number of facilities which had conferred rights to TDH had increased to 123 (80%). All facilities were enrolled and had conferred rights to Tennessee by the March 2013 CMS reporting deadline. Two facilities have been contacted in coordination with Network 8 to address potential infection control problems identified in surveillance data.

CONCLUSIONS:   OHD facilities offer unique challenges for HAI reporting, but the partnership between TDH and ESRD Network 8 helped 154 OHDs to successfully enroll in and begin reporting to NHSN. Ongoing priorities include continuous monitoring for intervention opportunities and increased emphasis on data quality.